Our law firm specializes in the wrongful denial of life insurance claims and accidental death claims. As such, we have seen life insurance companies make seemingly cruel claim denials more times than we can count. Yet, because we have to work with these companies regularly in order to get our clients’ claim denials overturned, we know that many of the people who work for these companies are not bad people.
To the contrary, they are people who are simply trying to do the job asked of them by an industry that is highly motivated by profits. The truth of the life insurance industry is that life insurance companies cannot make those profits if they simply pay every claim that is submitted to them. Indeed, some might say the lifeblood of their industry comes from denying as many claims as they possibly can.
There is one particular type of claim that life insurance companies seek to deny more than any other. Specifically, these are claims submitted under what are known as Accidental Death and Dismemberment (“AD&D”) riders. The reason life insurance companies hate AD&D riders so much is that they typically require the insurer to pay three times the policy amount in the event the insured dies in an accident.
As you can imagine, these claims are very expensive for a life insurance company. Therefore, these companies often declare that a policyholder’s death was not an accident even when all official reports about the death reach the opposite conclusion.
This article discusses one case where a man died in an unfortunate accident while doing something many of us do every summer. Nonetheless, the insurance company was so anxious to deny his wife's AD&D claim, that they tried to make his tragic an accidental death look like a suicide.
It was supposed to be a fun cookout
This case involved a man named Jeremy. Jeremy was 56 years old. He was married to a woman named Candace, and the two of them had 3 grown children. Jeremy was a research scientist for the local University and received a life insurance policy/AD&D rider from his employer. It was worth $500,000 with an additional $1,500,000 payout if Jeremy died in an accident. When he obtained the policy, he named Candace as his sole beneficiary.
One summer, Candace and Jeremy decided to have their kids and several of their friends over for a backyard barbecue. So many people were slated to show up that Jeremy had three different barbecue grills prepared for the evening's festivities. As he went to light the barbecues, however, he realized that he had purchased the wrong kind of charcoal for the barbeque.
He had intended to purchase charcoal that was already soaked in lighter fluid. These coals had no lighter fluid in them. After spending a half hour getting one of the barbecues started with newspaper, Jeremy decided to check the shed to see if he had an old can of lighter fluid. He did. As he walked the lighter fluid back toward the three grills, he made a fatal decision. He began spraying the fluid toward the coals while he was still a few feet away.
As he did that, the wind picked up and blew the stream of lighter fluid into the one barbecue that was already lit. An immediate ball of fire exploded along the trail of lighter fluid between that barbeque and Jeremy. Jeremy was immediately engulfed in flames. He died three days later from the resultant injuries.
Life insurer declares it was no accident
Candace later submitted a claim to Jeremy's life insurance company. It included a request for payout under the general policy as well as the AD&D rider. Within a few weeks’ time, Candace received the $500,000 payout but also received a claim denial from the insurance company with respect to the AD&D rider.
The company claimed that because Jeremy had been using a product (lighter fluid) with a label that warned him against doing the very thing he was doing when he died, he must have intended to intentionally harm himself. Because the AD&D rider had an exclusion for intentional harm, the life insurer claimed it had no obligation to pay out under that portion of the policy.
Candace was floored by the decision. She had never known anyone who enjoyed life more than Jeremy. Fortunately, a friend suggested that Candace contact an attorney specializing in the wrongful denial of life insurance claims. She did, and that decision change the outcome for the better.
The attorney went through a lengthy consultation with Candace. He also reviewed all of her claim documents, police reports from the incident, and he spoke with several people who knew Jeremy well. From this investigation, the attorney was confident that the very last thing Jeremy had intended was to harm himself.
The attorney put together a packet of evidence, a legal brief, and several sworn statements from Jeremy's family and friends who witnessed the incident. The statements talked about Jeremy’s love for life. Notably, the witnesses also stated that Jeremy had been in such a hurry to get the barbecues lit that evening that he didn’t even look at the can of lighter fluid, let alone read its warning labels. The attorney also submitted a sworn statement from Jeremy's doctors saying there had never been any indication that the man suffered from depression or any other mental illness.
The attorney submitted all of this evidence to the life insurance company’s internal appeals board with a request for a hearing. After reviewing all of the evidence and taking further testimony at a one day hearing, the appeals panel decided to overturn the denial of the AD&D claim.
While this was a good outcome for Candace, it is a stark reminder of what we know to be true about life insurance companies. They will often deny a claim they know they should pay just to see if they can break the will of the beneficiary and avoid making a policy payout.If you have received one of these bogus claim denials, please call our office today. Contesting wrongful life insurance claim denials is what we do every day. Let us help you.